血清肌钙蛋白I诊断急性心肌梗塞的研究

Serum cardiac troponin I for detecting acute myocardial infarction

用抗人心肌肌钙蛋白Ｉ（ｃＴｎＩ）单抗，建立酶联法检测血清ｃＴｎＩ，测健康人、室上性心动过速及陈旧性心梗患者的血清ｃＴｎＩ浓度为０～７μｇ／Ｌ（参照值）。重复检测差异小于８．７％，回收率１００．１％。６１例急性心肌梗塞（ＡＭＩ）病人血清ｃＴｎＩ均大于７μｇ／Ｌ。未溶栓患者胸痛后４～６小时血清ｃＴｎＩ上升，其峰值时间、上升曲线与ＣＫ－ＭＢ相似，峰值是参照值上限的２４倍。ｃＴｎＩ在血清中持续升高至少５天。溶栓治疗后血管再通病人血清ｃＴｎＩ峰值提前６小时，幅度增高。在溶栓治疗后８～１２小时，ｃＴｎＩ显著高于溶栓未通或未溶栓（未自溶）病人（Ｐ＜０．０５）。作者认为，用抗人ｃＴｎＩ单抗检测血清ｃＴｎＩ是诊断ＡＭＩ敏感与特异的指标之一。溶栓后连续检测ｃＴｎＩ还可能成为判断冠状动脉再通的指标之一。

To improve the specificity of biochemical markers of acute myocardial infarction (AMI), we established a double monoclonal “Sandwich” enzyme immunoassay to measure cardiac troponin I (cTnI) in serum. Samples from normal subjects, AMI and old MI patients were collected and assayed for cTnI and creatine kinase MB (CKMB) as well. Total assay imprecision of cTnI was less than 8.7% and recovery rate was 100.1%. The cTnI in normal subjects was 0 7ng/ml. In 61 patients with AMI, the serum cTnI increased markedly one week after the begining of chest pain, however the cTnI value in the cases of supraventricular tachycardia (SVT) and old MI was less than 7.0 ng/ml. In 42 cases of AMI without thrombolytic treatment, the increasing and the peak of serum cTnI were similar as serum CKMB, the peak cTnI was 24 times higher than the up limit of normal subjects. The positive detection rate of CKMB was only 14% from 48 hours to 5 days, meantime that of cTnI was 91%. In 13 patients of AMI with thrombolytic treatment within 6 hours following chest pain, reperfusion of ischemic myocardium was confirmed by clinic evidence and changes of ECG and CKMB, the peak of serum cTnI appeared 6 hours earlier and was 32 times higher than the up limit of normal controls. 6 12 hours following thrombolytic drug, the serum cTnI increased significantly in comparison with non thrombolytic group of AMI ( P < 0.05). It is concluded that the sensitivity and specificity of serum cTnI to diagnose AMI were excellent. Early and serial assays of cTnI might become a good marker to evaluate AMI and reperfusion.